International Journal of Orthopedics: Research & Therapy

1. International Journal of Orthopedics: Research & Therapy Research Article Anatomo-Clinical Results of Total Knee Arthroplasty After High Tibial Osteotomy - Rohimpitiavana HA1*, Rogero JM1, Marsili E1, Mondon D1, Ratsimandresy D2, and Razafi mahandry HJC3 1Departement of orthopaedics of Mont de Marsan Hospital, France 2Departement of orthopaedics of Bayonne Hospital, France 3Departement of orthopaedics of Joseph Ravoahangy Andrianavalona University Hospital. Antananarivo, Madagascar *Address for Correspondence: Rohimpitiavana HA, Departement of orthopaedics of Mont de Marsan Hospital, France, Tel: +002-613-468-05029; E-mail: Submitted: 22 July 2019; Approved: 27 November 2019; Published: 03 December 2019 Cite this article: Rohimpitiavana HA, Rogero JM, Marsili E, Mondon D, Ratsimandresy D, et al. Anatomo-Clinical Results of Total Knee Arthroplasty After High Tibial Osteotomy. Int J Ortho Res Ther. 2019;3(1): 011-016. Copyright: © 2019 Rohimpitiavana HA, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

2. International Journal of Orthopedics: Research & Therapy ABSTRACT The Principe of high tibial osteotomy is to reduce the stresses of the internal compartment of the knee by valgizing the tibia. The total knee arthroplasty on this tibia with a “malunion” presents technical diffi culties related to the initial approach, the presence of osteosynthesis material, the presence of malunion and the change of bone density. The objectives of this study are to determine the clinical and radiographic results of patients undergoing Total Knee Arthroplasty (TKA) after High Tibial Osteotomy (HTO). This is a retrospective descriptive study including patients undergoing Total Knee Arthroplasty (TKA) after an High Tibial Osteotomy (HTO) at the Hospital of Mont de Marsan (France) from 2008 to 2017 with a minimum follow-up of 12 months. Thirty knees (27 patients) were recruited. The sex ratio was 1.72. The average age was 70.33 years (54years-88years). The average time between High Tibial Osteotomy (HTO) and Total Knee Arthroplasty (TKA) was 10.83 years (1 year-26 years). The medial opening was 63.33% and lateral closure for the rest. Clinical improvement was observed, with an average gain of 24.97 points for pain, 1 point for stability, 1 point for knee mobility and 5 points for walking distance. The clinical result was perfect in 13.33%, excellent in 42% and medium in 36.67% of cases. The alignment was obtained in 76.67% of cases (p = 0.0039). The posterior tibial slope, epiphyseal varus, patellar height were corrected in 80% of cases respectivly (p = 0.000011, p = 0.44, p = 0.15). Residual pain was observed in 26.66%, joint stiff ness in 16.66%, skin healing disorder in 16% and infection in 6.66% of cases. Total knee arthroplasty made it possible to recover the failure of an high tibial osteotomy. Keywords: High tibial osteotomy; Total knee arhtroplasty; Results INTRODUCTION High Tibial Osteotomy (HTO) is a procedure performed frequently in young patients less than 60 years old [1] for degenerative osteoarthritis or post-traumatic osteoarthritis [2-4]. Its purpose is to avoid or delay the placement of a prothesis. But aft er one or two decades, the eff ect of the osteotomy can be exhausted and the patient’s symptoms reappear. At this time, it is necessary to have Total knee Arthroplasty (TKA). Th e principle of tibial valgus osteotomy is to reduce the stresses of the internal compartment of the knee by valgizing the tibia. Th e placement of a prosthesis on a tibia with a “malunion” has some technical peculiarities or diffi culties related to the initial approach, the presence of material, and the change in bone density. From the technical point of view, the existence of a prior osteotomy can modify the planning of the surgical procedure, not only in the approach but also in the technical realization, whether bone cuts, ligament balance, the need for a particular implant, even customized [5-7]. Th e results of Total knee Arthroplasty (TKA) aft er High Tibial Osteotomy (HTO) are variously appreciated in the literature [8-10]. Th e objective of this study is to determine the anatomical and clinical results of a Total knee Arthroplasty (TKA) aft er High Tibial Osteotomy (HTO). PATIENTS AND METHOD Th e study was conducted in the department of Orthopedic Surgery of Layne Hospital of Mont de Marsan. Th is is a descriptive and analytic retrospective study of patients undergoing total knee arthroplasty aft er a tibia valgization osteotomy. Th e study was conducted over a period of 10 years (2008 to 2017) with a decline of 1 year. Included were all patients operated on a total knee arthroplasty procedure having a tibia valgus osteotomy on the same side as antecedent. Non-inclusion criteria included femoral osteotomies, unicompartmental prosthesis osteotomy, and osteotomy. Incomplete fi les were excluded. For the evaluation of the knee, the International Knee Society Score (IKS Knee Score) was used. Th e results were ranked according to the score in: Regarding the evaluation of the function, we do not have all the elements to establish the IKS score. We evaluated only the walking perimeter that will be rated according to the IKS function from 0 to 50. Th e results were classifi ed into: Excellent: Unlimited time • Good: > 1km • Medium: 500m-1km • Bad: < 500m • Th e anatomical results were analyzed pre and postoperatively on a pangonnogram for the alignment with Hip Knee Ankle measurement (HKA) and for the epiphyseal varus on a radiograph of the knee in profi le incidence for the posterior inclination of tibial articular surface and patellar height by the Caton index. Collected data was entered on Microsoft Word and Microsoft Excel and processed by Epi info 7. Th e results are signifi ant for a value of p < 0.05. Th is study was approved by Institutional Review Board. Characteristics of the series Th is is a series of 30 knees (27 patients) undergoing Total knee Arthroplasty (TKA) aft er High Tibial Osteotomy (HTO). A male predominance was observed with a sex ratio of 1.72 (19 men and 11 women). Th e average age of our patients was 70.33 years (54 years - 88 years). Th e average age of the patients at the time of their osteotomy was 54.85 years (39 - 71 years). In most cases, it was a right knee (63.33%). Th ree bilateral cases were listed. Th e average time between High Tibial Osteotomy (HTO) and Total knee Arthroplasty (TKA) was 10.83 years (1 year - 26 years). Th e medial opening High Tibial Osteotomy (HTO) was 63.33% and lateral closure for the rest. An unconstrained Total knee Arthroplasty (TKA) are used. RESULTS Clinical results Pain: Regarding pain, a clear improvement was observed with an average gain of 24.97 points according the IKS score (Figure 1). Perfect: 100 • Pre-operative SD +/ - 5.64 • Excellent: 80-100 • Post-operative SD +/- 6.39 • Medium: 60-100 • Mobility: An increase in knee mobility was obtained at 1 year postoperatively with a gain of 1 point (Figure 2). Bad: < 60 • SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page -012

3. International Journal of Orthopedics: Research & Therapy Pre-operative SD +/- 4.12 • 25 Post-operative SD +/ - 1.91 • Stability: Stability has been improved aft er arthroplasty. Th e diff erence is not important because the majority of the knees were stable before the intervention. We an average of 23.83 preoperative points to 25 points post-operatively. All knees were stable aft er arthroplasty (Figure 3). 20 15 Stability 10 Pre-operative SD +/ - 2.84 • 5 Post-operative SD +/ - 0 • KneeIKS: Clinical examination of the knee was better aft er arthroplasty. Th e result was excellent in 42% of the cases, “perfect” and “medium” respectively in 13.33% and 36.67% of the cases (Table 1). Th e pain is signifi cantly improved. We have an average gain of 31.91 points. 0 pre-opéra?ve 1 year post-opera?ve Figure 3: Evolution of stability 1 year postoperative. Perimeter of march: Aft er intervention, 36.37% of cases have an unrestricted perimeter of march. More than half of the cases happen to walk more than 1 km (63.33%). Compared to the perimeters of walking preoperatively, a clear improvement was observed (Figure 4). Table 1: Case distribution according to IKS knee pre and 1 year postoperative. Preoperative Postoperative n = 30 Percentage n = 30 Percentage Perfect Excellent Medium Bad 0 5 11 14 0% 4 13.33% 42% 36.67% 0% Pre-operative SD +/ - 4.0115 • 16.66% 36.66% 46.66 21 5 0 Post-operative SD +/ - 2,39 • Anatomical results Preoperative Postoperative Alignment: An improvement in knee alignment was observed at 1 year postoperatively. Th ey are normalized in ¾ cases. In 20% of cases, knees remain in varus and valgus in 3.33% of cases. Two cases showed signifi cant deformity > 10°C postoperatively. One case of deformity was due to a knee injury resulting loosening of the femoral implant. n = 30 Percentage n = 30 Percentage Perfect/ excellent Medium/ Bad p = 0.0000002 5 16.66% 25 33.33 % 25 83.33% 5 16.66 % 48 46.66 42.5 45 47 40 46 45 35 44 30 Walking perimeter 43 25 41.67 42 pain 17.53 20 41 15 40 10 39 pre opera?ve 1 year post-opera?ve 5 0 pre opera?ve 1 year post opera?ve Figure 4: Evolution of walking perimeter 1 year postoperative. It was resumed but beyond the fi rst year of arthroplasty where we evaluated the result. Th e other case was observed in a patient with a fl essum maintained by a contralateral fl essum. Th e measurement could be infl uenced by this fl essum (Table 2). Figure 1: Evolution of pain 1 year postoperative. 25 24 Tibial posterior slope: We found that the majority of patients experienced a signifi cant posterior inclination of tibial articular surface before the surgery (76.67%). Th is important posterior inclination of tibial articular surface has been corrected postoperatively by Total Knee Arthroplasty (TKA) (Table 3). 23 Mobility 21.7 22 20.7 21 Epiphyseal varus: Th e epiphyseal varus was corrected in 80% of the cases aft er the intervention. Before the intervention, the deformity concerned half of the cases (p = 0.44). 20 pre opera?ve 1 year post opera?ve Figure 2: Evolution of mobility 1 year post-operative. Patellar height: Patellar height was normal in 80% of cases aft er SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page -013

4. International Journal of Orthopedics: Research & Therapy score, with a fl exion gain of 32° [20]. In our study, we had 13.33% of perfects IKS, 42% of excellents IKS and 36.67% of medium IKS. In comparison, Eymar and al had 86,1% excellents (IKS Knee score > 80) and perfects in 34,5% (IKS Knee score = 100) [16]. Table 2: Distribution of cases according to alignment before and 1 year postoperatively. Preoperative n = 30 Percentage Varus 13 43.33% Normal 12 40% Valgus 5 16.67% Postoperative n = 30 6 23 1 Percentage 20% 76.67% 3.33% To ensure stability, soft tissue balance should be considered. During open-wedge High Tibial Osteotomy (HTO). Th e superfi cial Medial Collateral Ligament (MCL) and/or pes anserinus are usually released, and these can cause valgus laxity or instability. Pape, et al. [21] performed biomechanical testing, and reported that the anteriorfi bres of the superfi cial Medial Collateral Ligament (MCL) play a crucial role in maintaining valgus stability; thus, the release of the superfi cial Medial Collateral Ligament (MCL) for open-wedge High Tibial Osteotomy (HTO) should be maintained to prevent the potential of late valgus instability. Medial instability can also occur aft er plate removal during the Total Knee Arthroplasty (TKA) conversion due to the required medial release. Because the distal Medial Collateral Ligament (MCL) is usually released in open-wedge High Tibial Osteotomy (HTO), the proximal Medial Collateral Ligament (MCL) release in converting to Total Knee Arthroplasty (TKA) can aff ect the distal Medial Collateral Ligament (MCL), which can cause medial instability. Th erefore, the elevated distal portion of the Medial Collateral Ligament (MCL) should be placed in situ on the graft bone, and pes anserinus, if released, should be repaired during open-wedge High Tibial Osteotomy (HTO) to prevent medial instability. Many surgeons usually release the superfi cial Medial Collateral Ligament (MCL) subperiosteally distal to the osteotomy site, or completely cut it at the osteotomy site without repair when performing open- wedge High Tibial Osteotomy (HTO) [10]. Similarly, the higher rates of lateral release following a lateral closing wedge High Tibial Osteotomy (HTO) are most likely due to postoperative scarring that occurs on the lateral side of the knee following osteotomy [22]. Preoperative Postoperative n = 30 18 12 Percentage 43.33% 40% n = 30 7 23 Percentage 20% 76.67% Varus/ Valgus Normal p = 0.0039 Table 3: Distribution of cases according to the modifi cation of the posterior inclination of tibial articular surface. Preoperative n = 30 Percentage 0°-3° 7 23.33% 3° 23 76.67% p = 0.00001124 Postoperative n = 30 24 6 Percentage 80% 20% surgery. Th e arthroplasty made it possible to raise the height of the patella, of which 26.67% of the cases were low before the intervention (p = 0.15). COMPLICATIONS Th irteen cases (43.33%) had complications whose pain predominated (26.66%), followed by joint stiff ness (16.66%). Of these, two cases benefi ted from mobilization under general anesthesia. Two skin necroses were observed. For this, we realized an internal gastrocnemius fl ap associated with a skin graft . DISCUSSIONS High Tibial Osteotomy (HTO) is an eff ective solution for the treatment of medial isolated knee osteoarthritis in young patients [11]. By changing the mechanical axis of the lower limb, the medial compartment of the knee is discharge, providing patients with reliable relief of pain [12,13]. However, about 24% of these osteotomies were resumed before 10 years, regardless of the initial technique used [14]. Th is High Tibial Osteotomy (HTO) for it to be eff ective is at the origin of a “malunion” of the proximal epiphysis of tibia. Th e good results are observed signifi cantly when there is a valgus overcorrection of at least 3° of the global axis of the lower limb. Th is corresponds to an epiphyseal valgus of more than 2° [14]. In peroperative, the objectives of the surgeon are to replace the knee joint by correcting this malunion and ensuring stability of the knee. Th e majority of patients (63.33%) managed to walk more than 1000 meters and 36.66% of cases had an unlimited walking distance. Th e result of our study was consistent with that of Burdin, et al. [9] on a series of 189 knees at an average follow-up of 4.3 years and with that of Heejune, et al. [8]. In contrast, most studies have shown a lower quality of outcome than fi rst intention Total Knee Arthroplasty (TKA) [10,23]. While other authors have reported that a conversion to Total Knee Arthroplasty (TKA) aft er High Tibial Osteotomy (HTO) is not clinically diff erent from a Total Knee Arthroplasty (TKA) performed without prior High Tibial Osteotomy (HTO) [24]. In terms of anatomical results, this study showed that knee arthroplasty restore alignment, posterior inclination of tibial articular surface, epiphyseal varus and patellar height. Regarding alignement, two cases showed signifi cant deformity > 10°C postoperatively. One case of deformity was due to a knee injury resulting loosening of the femoral implant. It was reoperated but beyond the fi rst year of arthroplasty where we evaluated the result. Th e other case was observed in a patient with a fl essum maintained by a contralateral fl essum. Th e measurement could be infl uenced by this fl essum. Van Raaij, et al. [18] showed an amelioration of alignement (optimal 6° valgus) and an increase of patella height postoperatively. Th ere is no signifi cant diff erences for alignment and patellar height between primary Total Knee Arthroplasty (TKA) aft er osteotomy. Th e tibial component was placed with signifi cantly (p = 0.025) less posterior slope aft er Total Knee Arthroplasty (TKA) aft er osteotomy group, respectively 7° (range 0 to 12°) and 12° (range 2 to 20°) aft er primary Total Knee Arthroplasty (TKA) [15]. Other studies have shown that medial osteotomy is a provider of low patella infera and external Th is study showed that total knee arthroplasty improve the clinical manifestations and radiographic signs of the knee of our patients. A marked improvement of the pain was observed with a gain of 25.17 points. VanRaaij, et al. [15] using the Analog Visual Scale (VSA) have found an improvement of pain. An increase in the articular amplitude of the knee with an average gain of 1 point or 5° compared to the preoperative state. According to the literature, the ideas are diparates. Van Raaij, et al. [15] found an increase in the average amplitude of 10°. On a study of Eymar [16], Meding, et al. [17], they showed that there is no signifi cant modifi cation in pre and post-operative. All knees remained stable at 1 year of operation. Retrospective series confi rm improved clinical scores, but at the cost of relatively high rates of complications, revision and alignement default [18,19]. Gupta and al. observed a gain of 50 points for the IKS SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page -014

5. International Journal of Orthopedics: Research & Therapy osteotomy changes the morphology of the upper extremity of the tibia [25-27]. Recently, open-wedge High Tibial Osteotomy (HTO) has become more popular than closed wedge High Tibial Osteotomy (HTO) due to advantages that include easier correction of deformity, proximal bone preservation and the ability to avoid peroneal nerve injury [28]. a study looking for the factors of poor results should be carried out. Identifying these factors would allow for planning to improve intervention techniques and strategies. REFERENCES 1. Dubrana F, Lecerf G, Nguyen-Khanh JP, Menard R, ArdouinL, Gibon Y, et al. Osteotomie tibiale de valgisation. Revue de chirurgie orthopedique etreparatrice de l’appareil moteur. 2008; 94: 2-21. Concerning anatomical changes, the tibial obliquity may have changed to valgus; thus, the medial plateau may be positioned higher than the lateral plateau. If the tibial bone cutting is performed perpendicular to the mechanical axis, it can cause an asymmetric resection that may result in resection laxity and thus increase the risk of imbalance [29]. Th e posterior tibial slope tends to be increased aft er an open-wedge High Tibial Osteotomy (HTO), and this change can cause anterior tibial translation and instability infl exion. In addition, this change can cause a large anterior tibial resection and defects in the posterior tibia, which can aff ect gap balancing during both fl exion and extension [30]. Th ese changes can cause diffi culty in patellar eversion during the Total Knee Arthroplasty (TKA). Sometimes, an osteotomy of tibial anterior tuberosity is necessary. 2. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987; 69: 332-354. https://bit.ly/2smvkks 3. Hernigou P, Roussignol X, Flouzat-Lachaniette CH, Filippini P, Guissou I, Poignard A. Opening wedge tibial osteotomy for large varus deformity with ceraver resorbable beta tricalcium phosphate wedges. Int Orthop. 2010; 34: 191-199. http://bit.ly/34Etk56 4. Hernigou P, Queinnec S, Picard L, Guissou I, Naanaa T, Duffi et P, et al. Safety of a novel high tibial osteotomy locked plate fi xation for immediate full weight-bearing: A case-control study. Int Orthop. 2013; 37: 2377-2384. http:// bit.ly/2Y3zQjL 5. Windsor RE, Insall JN, Vince KG. Technical considerations of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg Am. 1988; 70: 547-555. http://bit.ly/2qRlDdm In our study, only 13.33% of cases had an perfect result. Forty two percent had an excellent clinical outcome and 36.67% of the cases had a medium clinical outcome. Several factors not identifi ed in this study could be the explanations for this results. 6. Bergenudd H, Sahlstrom A, Sanzen L. Total knee arthroplasty after failed proximal tibial valgus osteotomy. J Arthroplasty. 1997; 12: 635-638. http://bit. ly/2soYxv8 Th e complications were frequent. According to the literature, complications of Total Knee Arthroplasty (TKA) aft er osteotomy are more common than aft er fi rst-intention Total Knee Arthroplasty (TKA) [31,32]. Th e pain predominated (26.66%). Th is pain was present on the anterior face of the knee, which for some patients was related to patellar tendinopathy, while in others it was associated with other complications such as cutaneous necrosis and infection. Other chronic pain has been observed in patients who have never been well aft er High Tibial Osteotomy (HTO). Joint stiff ness accounted for 16.66% of cases. It was secondary to delayed healing (10%), cutaneous necrosis (6.66%) or infection (6.66%) that prevented or delayed functional rehabilitation sessions. According to the meta-analysis conducted by Beswick, et al. [31] in 2012, 17 to 31% of patients having benefi ted Total Knee Arthroplasty (TKA) suff ered from chronic post-surgical pain. It is a complex phenomenon, involving multiple mechanisms whose predictive factors could be pre, per, or postoperative [32]. To prevent skin necrosis, the skin incision of the previous High Tibial Osteotomy (HTO) must be considered. If the previous incision cannot be used, the new incision should be at least six centimetres away from older incision [33]. 7. Haddad FS, Bentley G. Total knee arthroplasty after high tibial osteotomy: A medium-term review. J Arthroplasty. 2000; 15: 597-603. http://bit.ly/2shl90m 8. Parvizi J, Hanssen AD, Spangehl MJ. Risques de descellement majore pour les PTG apres Osteotomie. J Bone Joint Surg (Am). 2004; 86: 474-479. 9. Burdin P. Analyse de 234 protheses totals de genou en reprise d’une osteotomie tibiale de valgisation. Compte rendu SFGH. 273. 10. Kim HJ, Kim YG, Min SG, Kyung HS. Total knee arthroplasty conversion after open-wedge high tibial osteotomy: A report of three cases.Knee. 2016; 23: 1164-1167. http://bit.ly/33oKvGI 11. Gstottner M, Pedross F, Liedensteiner M, Bach C. Long term outcome after high tibial osteotomy. Arch Orthop Trauma Surg. 2008; 128: 111-115. http:// bit.ly/34nAbjr 12. Preston S, Howard J, Naudie D, Somerville L, McAuley J. Total knee arthroplasty after high tibial osteotomy: no diff erences between medial and lateral osteotomy approaches. Clin Orthop Relat Res. 2014; 472: 105-110. https://bit.ly/2qSqefo 13. Chen Y, Xingquan X, Sheng Z, Xiaoxiao S, Dongquan S, Qing J. Total knee arthroplasty conversion after a failed lateral closing wedge high tibial osteotomy with knee hyperextension and secondary ankle degeneration. Medicine (Baltimore). 2017; 96: 7473. http://bit.ly/33tTS82 However, the other complications observed in our study were more frequent compared with those of the other studies [34]. Burdin, et al. [9] on their study of a series of 263 cases reported 3.04% skin complications (2.28% cutaneous necrosis and 0.76% delayed healing), 0.76% cracks, 0.76% fractures, 0.76% hematoma. 14. Whiteside LA. Exposure in diffi cult total knee arthroplasty using tibial tubercle osteotomy. Clin Orthop Relat Res. 1995; 321: 32-35. https://bit.ly/35EjVe6 15. van Raaij TM, Bakker W, Reijman M, Verhaar JA. The eff ect of high tibial osteotomy on the results of total knee arthroplasty: A matched case control study. BMC Musculoskelet Disord. 2007; 74. https://bit.ly/2XVBSly Performing a Total Knee Arthroplasty (TKA) aft er High Tibial Osteotomy (HTO) requires careful surgical planning and caution owing to several anatomical changes that occur aft er High Tibial Osteotomy (HTO) [8,30,33]. CONCLUSION Total Knee Arthroplasty (TKA) can recover the failure of a tibial osteotomy. However, the complications were frequent and the results were inferior to those of a Total Knee Arthroplasty (TKA) without previous osteotomy. In order to optimize the clinical outcome, 16. Eymard F, Charles NA, Katsahian S, Chevalier X, Bercovy M. The concept of “forgotten knee” after total knee replacement: A single-center study pragmatic cohort. Review of Rheumatism. 2016; 83: 209-212. http://bit.ly/2OSAZGA 17. Meding JB, Wing JT, Ritter MA. Does high tibial osteotomy aff ect the success or survival of a total knee replacement?. Clin Orthop Relat Res. 2011; 469: 1991-1994. https://bit.ly/2DAF50V 18. Van Raaij TM, Reijman M, Furlan AD, Verhaar JA. Total knee arthroplasty following high tibial osteotomy. A systematic review. BMC Musculoskelet Disord. 2009; 10: 80. http://bit.ly/33wkjtv SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page -015

6. International Journal of Orthopedics: Research & Therapy 19. Niinimaki T, Eskelinen A, Ohtonen P, Puhto AP, Mann BS, Leppilahti J. Total knee arthroplasty after high tibial osteotomy: A registry-based case-control study of 1,036 knees. Arch Orthop Trauma Surg. 2014; 134: 73-77. https:// bit.ly/2qRU4k8 27. Scuderi GR, Windsor RE, Insall JN .Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg (Am). 1989; 71: 245-248. http:// bit.ly/34uUJXc 28. Hooper G, Leslie H, Burn J, Schouten R, Beci I. Oblique upper tibial opening wedge osteotomy for genuvarum. Oper Orthop Traumatol. 2005; 17: 662- 673. http://bit.ly/37L5arJ 20. Himanshu Gupta, Vivek Dahiya, Attique Vasdev, Ashok Rajgopal. Outcomes of total knee arthroplasty following high tibial osteotomy. Indian J Orthop. 2013; 47: 469-473. http://bit.ly/2OpQpTw 29. Han JH, Yang JH, Bhandare NN, Suh DW, Lee JS, Chang YS, et al. Total knee arthroplasty after failed high tibial osteotomy: A systematic review of open versus closed wedge osteotomy. Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2567-2577. http://bit.ly/2OUUEp4 21. Pape D, Duchow J, Rupp S, Seil R, Kohn D. Partial release of the superfi cial medial collateral ligament for open-wedge high tibial osteotomy A human cadaver study evaluating medial joint opening by stress radiography. Knee Surg Sports Traumatol Arthrosc. 2006; 14: 141-148. https://bit.ly/2KWnPqT 30. Erak S, Naudie D, MacDonald SJ, McCalden RW, Rorabeck CH, Bourne RB. Total knee arthroplasty following medial opening wedge tibial osteotomy: technical issues early clinical radiological results. Knee. 2011; 18: 499-504. http://bit.ly/2OKZiG8 22. Bastos Filho R, Magnussen RA, Duthon V, Demey G, Servien E, Granjeiro JM, et al. Total knee arthroplasty after high tibial osteotomy: A comparison of opening and closing wedge osteotomy. Int Orthop. 2013; 37: 427-431. https:// bit.ly/33rkZAs 31. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012; 2: 000435. http://bit.ly/2DqTvR6 23. Efe T, Heyse TJ, Boese C, Timmesfeld N, Fuchs WS, Schmitt J, et al. TKA following high tibial osteotomy versus primary TKA - a matched pair analysis. BMC Musculoskeletal Disorders. 2010; 11: 207. http://bit.ly/37PqMU7 24. Karabatsos B, Mohamed NN, Maistrelli GL. Functional outcome of total knee arthroplasty after high tibial osteotomy. Can J Surg. 2002; 45: 116-119. http:// bit.ly/2OQWlnN 32. Martinez V, Baudic S, Fletcher D. Douleurs chroniques postchirurgicales. Ann Fr Anesth Reanim. 2013; 32: 422-435. http://bit.ly/34ue4YL 33. Cerciello S, Vasso M, Maff ulli N, Neyret P, Corona K, Panni AS. Total knee arthroplasty after high tibial osteotomy. Orthopedics. 2014; 191-198. 25. Dohin B, Migaud H, Gougeon F, Duquennoy A. Eff ect of a valgisation osteotomy with external wedge removal on patellar height and femoro- patellar arthritis. Acta Orthop Belg. 1993; 59: 69-75. http://bit.ly/2qUNMA9 34. Han JH, Yang JH, Bhandare NN, Suh DW, Lee JS, Chang YS, et al. Total knee arthroplasty after failed high tibialosteotomy: A systematic review of open versus closed wedge osteotomy. Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2567-2577. http://bit.ly/2OUUEp4 26. Kaper BP, Bourne RB, Rorabeck CH, McDonald SJ. Patella infera after high tibial osteotomy. J Arthroplasty. 2001; 16: 168-173. http://bit.ly/35KyywG SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page -016